Neighborhood Walkability Index and Its Association With Indices of Childhood Obesity in Bengaluru, Karnataka

Background: The prevalence of childhood obesity is increasing in low-middle income countries like India. Built environment features such as walkability can influence weight-related outcomes but data from developing countries are scanty. Objective: To develop population level walkability index in urban Bengaluru, and examine its association with indices of childhood obesity in school children. Study Design: Nested cross-sectional study based on a cohort. Participants: Normal healthy children aged 6 to 15 years from urban schools in Bengaluru. The children were stratified into different land use classification such as residential, commercial and open space based on residential address. Methods: Anthropometric data, body composition data, measured using air displacement plethysmography. Outcomes: Walkability index derived using residential density, street connectivity and land-use mix environment variables. Results: The mean (SD) of age, body mass index (BMI), BMI zscore and percentage body fat (% Body fat) of 292 (50% boys) children were 10.8 (2.9) year, 17.4 (3.3) kg/m2, -0.27 (1.35) and 20.9% (8.8), respectively. The mean (SD) walkability index was 16.5, which was negatively associated with BMI (slope -0.25 and -0.08) and percentage body fat (slope -0.47 and -0.21) for age 5 and 10 years, respectively in children, but the effects decreased with increasing age. Conclusions: The findings of this pilot study suggest that the neighborhood walkability may be associated with the obesity indices in younger children. Future longitudinal studies are needed to understand how built environment affects health and body composition of children in India and other low-middle income countries.

Risk Factors for Catheter-Associated Urinary Tract Infections (CA-UTI) in the Pediatric Intensive Care Unit

Objective: To describe the occurrence, microbiology, and risk factors of catheterassociated urinary tract infections (CA-UTI) in critically ill children. Methods: We conducted a review of hospital records for CA-UTI in the pediatric intensive care unit (PICU) over a 7- year period (2014-2020). Results: 62 CA-UTI cases (48% boys, median (IQR) age 36 (12,96 month) were identified during the study period with occurrence rate of 7.2/1000 catheter-days. The most common organisms were Escherichia coli (32.4%) and Enterococcus faecalis (30.6%). Using a multivariate logistic regression analysis, the significant associated variables for CA-UTI were duration of catheter drainage (a OR (95% CI) 1.14, (1.03,1.27), P=-0.009), PICU stay (aOR (95% CI) 1.13 (1.05,1.21) (P<0.001), and hospital stay (aOR (95% CI): 1.03 (1.01,1.06), P=0.015). Conclusion: CA-UTI is not an uncommon nosocomial infection in PICU. The risk increases with increasing duration of catheter drainage, and hospital or PICU stay.

Association of Vitamin A Status With Under-Five Mortality in India

Objective: To re-estimate the survival benefit from Vitamin A supplementation (VAS) in India using meta-analysis and to correlate mortality and vitamin A deficiency (VAD) in children aged 6 month to 5 year. Methods: Pooled risk ratio (fixed effects model) for mortality reduction with VAS was calculated from available Indian studies. Computed mortality rates in 6 months to 5 years children in Indian states were regressed on VAD prevalence estimates of the states. Results: There was no reduction in risk of all-cause mortality with VAS (RR=0.96; 95% CI: 0.89, 1.03). When regressing mortality on VAD in high or low VAD prevalence states, the regression coefficients were discordant. Conclusion: No survival benefit was observed for VAS in India from the available literature. The targeting of VAS programs should be given serious consideration.

Daily Iron Requirements in Healthy Indian Children and Adolescents

Objective: This study aimed to define the estimated average requirement and therecommended dietary allowance of iron for Indian children and adolescents. Methods: TheEstimated average requirement was derived for children aged 1-17y, from the meanbioavailability-adjusted daily physiological iron requirement, which in turn was estimatedusing a factorial method. This consisted of mean daily iron losses from the body andadditional iron required for tissue growth and storage, while also defining the variance of eachfactor to derive the Recommended dietary allowance. Results: The estimated averagerequirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1-9y. Foradolescents aged 10-17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d foradolescent boys and girls, respectively. Conclusion: New estimates of estimated averagerequirement for iron in Indian children are presented, and same may be used to inform ironsupplementation and food fortification policies.

Comparison of clinical profile of urban vs. rural Indian youth with premature coronary artery disease (PCAD): a sub-study of the PCAD registry

Background: We aimed to compare clinical profile of premature coronary artery disease (PCAD) in urban vs. rural Indian populations.Methods: This was a prospective cross-sectional observational multi-centre study. This study is a sub-study of the ongoing PCAD registry. Between the period April 2017 and April 2018, a total of 1061 patients <40 years with PCAD were studied. Urban (n=583) and rural (n=478) populations were statistically compared.Results: Mean age of the urban and rural populations were 34.50±4.15 years and 33.99±4.46 years, respectively. All cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidemia, obesity, diet and family history), except for alcoholism were more prevalent in urban subjects compared to rural subjects. However, higher prevalence of only hypertension (p=0.05) was statistically significant. Religion was significant between the two populations (p<0.001). Window period was also significant between the two populations (p<0.001). Very low density lipoprotein cholesterol (VLDL) (p=0.037) was significantly different between both populations.Conclusions: All conventional risk factors were more prevalent among urban populations than rural populations, however none of these differences except for hypertension was statistically significant.

Integrating Ethics into the Physiology curriculum: a scale-up study in three medical colleges in Karnataka, South India

A published pilot study showed the feasibility of integrating ethics into physiology in a single medical college. However, questions were raised about feasibility of scale-up and acceptance across different colleges. To assess feasibility of integrating ethics into Physiology, first year MBBS students of three medical colleges (n=449, College A=149; 59M, 90F; College B=150; 78M, 72F; College C=150; 48M, 102F) were exposed to the integrated ethics programme. Triggers related to theory or practicals were included. Faculty volunteers conducted the sessions with feedback from observers and students. Students across three colleges felt that the programme was relevant (92%–98%), effectively integrated (86%–98%) [significantly greater number of College A students: (p=0.003)], seldom interfered with physiology teaching (59%–66%). Greater number of students from College C followed by College B and A opined to continue the integrated programme for future years (p=0.004). A scale-up study of integration of ethics programme across different colleges was perceived to be feasible by students and observers.

Influence of angiotensin converting enzyme (ACE) gene rs4362 polymorphism on the progression of kidney failure in patients with autosomal dominant polycystic kidney disease (ADPKD).

Background & objectives: Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder, characterized by the fluid filled cysts in the kidneys leading to end stage renal failure in later years of life. Hypertension is one of the major factors independently contributing to the chronic kidney disease (CKD) progression. The renin-angiotensin aldosterone system (RAAS) genes have been extensively studied as hypertension candidate genes. The aim of the present study was to investigate the role of angiotensin converting enzyme tagging - single nucleotide polymorphisms (ACE tag-SNPs) in progression of CKD in patients with ADPKD. Methods: In the present study six ACE tagSNPs (angiotensin converting enzyme tag single nucleotide polymorphisms) and insertion/deletion (I/D) in 102 ADPKD patients and 106 control subjects were investigated. The tagSNPs were genotyped using FRET-based KASPar method and ACE ID by polymerase chain reaction (PCR) and electrophoresis. Genotypes and haplotypes were compared between ADPKD patients and controls. Univariate and multivariate logistic regression analyses were performed to assess the effect of genotypes and hypertension on CKD advancement. Mantel-Haenszel (M-H) stratified analysis was performed to study the relationship between different CKD stages and hypertension and their interaction. Results: All loci were polymorphic and except rs4293 SNP the remaining loci followed Hardy-Weinberg equilibrium. Distribution of ACE genotypes and haplotypes in controls and ADPKD patients was not significant. A significant linkage disequilibrium (LD) was observed between SNPs forming two LD blocks. The univariate analysis revealed that the age, hypertension, family history of diabetes and ACE rs4362 contributed to the advancement of CKD. Interpretation & conclusions: The results suggest that the ACE genotypes are effect modifiers of the relationship between hypertension and CKD advancement among the ADPKD patients.